Lisa Gilbert

Served as subject matter resource and assisted in completing tasks working with other staff of Sheakley UniComp: Billing, Medical Dispute, Drug Utilization Review, Utilization Management, Return to Work Specialists and Settlement Coordinators to work with Injured Workers of Ohio to receive medically necessary care with the Ohio Bureau of Worker's Compensation.

Clinical Liaison tasks: Assisting in completing BWC physician orders for medical care, reviewing the appropriate use of prescribed medications, monitoring the medical necessity of care prescribed psychiatric care and medical care pre-and post-claim settlement.

Served as subject matter resource, providing information related to medical necessity of hospitalization care (outpatient testing/surgery, short and long hospitalizations), writing letters of medical necessity.

Evaluated medical guidelines and benefit coverage to determine appropriateness of services using the guidelines of MCG, InterQual and current medical journal articles.

Have written appeals for medical necessity to multiple insurance providers in a reconsideration, first and second level appeals. Providers: Advantra, Aetna, Ambetter, Anthem (Blue Cross Blue Shield), CareSource, Coventry Healthcare, Humana, Kaiser Permanente, Medicare, Medial Mutual United Healthcare ad WellCare.

Medical necessity letter content included issues of administration, authorization of service(s) or hospitalization, DRG down-coding, lack of medical necessity.

Was part of initial staff of the ICU when this facility opened in November 2012.

Interpersonal, written and computer communication with medical/nursing/ancillary staff and family of patients.

Care of 1 to 2 critically ill patients according to acuity.

Skills include nursing care of cardiac, surgical, pulmonary and neurologic patients.

Supervised new employees and student nurses to promote established patient care standards and practices.

Continued to participate in continuing education as the job and Ohio Board of Nursing license required.

Was part of initial staff of the ICU when this facility opened in November 2012.

Interpersonal, written and computer communication with medical/nursing/ancillary staff and family of patients.

Care of 1 to 2 critically ill patients according to acuity.

Skills include nursing care of cardiac, surgical, pulmonary and neurologic patients.

Supervised new employees and student nurses to promote established patient care standards and practices.

Continued to participate in continuing education as the job and Ohio Board of Nursing license required.

• Managed patients recovering from medical or surgical procedures.
• Developed and implemented individualized patient care plans for optimal outcomes.
• Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
• Educated family members and caregivers on patient care instructions.